Pediatric Emergency Unit Research Articles

Acute Kidney Injury in Critically Ill Patients in Intensive Care Unit

Foundation and destinations .Acute kidney injury (AKI) is related with unfavorable results, particularly in youngsters admitted to the pediatric emergency unit). AKI is a typical inconvenience related with longer medical clinic length of remain, increment of dismalness and mortality in kids who require concentrated consideration. Around then the RIFLE (Risk Injury Failure Loss End stage) score fills in as an appropriate characterization of AKI when defined by clinical seriousness. This investigation done to decide the frequency, etiology of AKI, pointer of casualty and transient result of AKI in fundamentally sick youngsters. Subjects and Methods:This imminent examination incorporate 200critically sick patients with at least one framework disappointment admitted to the PICU during the time of study. Consideration measures was successive patients admitted to the PICU. Avoidance rules - was Patients with known interminable kidney infection stage 5 (assessed glomerular filtration rate < 15 ml/min/1.73 m2). They were screened for AKI, characterized by the pRIFLE measures. The patients with AKI were followed-up until release/demise. Their clinical and biochemical information were recorded. All patients were exposed to: full history including the etiology of PICU confirmation and reasons for intense kidney injury. Nitty gritty fundamental assessment, including indispensable signs, cardiovascular and different frameworks. Fundamentally sick patients were characterized on the off chance that at least one of the rules which present during a 24-hr period as per organ brokenness standards . Research center Investigations were incorporated finished blood check, C-receptive protein, blood vessel blood gases, corrosive base status, blood urea, serum creatinine , electrolytes, blood glucose, serum bilirubin level, cerebrospinal liquid examination and culture for bacteriologic investigations (blood, endotracheal suction, and cerebrospinal fluid)when required. results: The occurrence of AKI among 200 patients screened was 54 (27%). The basic etiologies in AKI bunch were contaminations, 28 (51.8%), stun 18(33.3%), intense glomerulonephritis 2 (3.7%), cardiovascular disappointments 4(7.4%) and status epilepticus 2(3.7%). Among diseases, pneumonia and septicemia comprised 78.5%, meningoencephalitis represented 21.5% and 6 (11) % of patients required dialysis. In general mortality in AKI bunch was 37%. On strategic relapse examination, necessity of mechanical ventilation was a free indicator of casualty in AKI gathering.

Is there an interest for hair analysis in non-intentional pediatric cannabis intoxication?

Background and objectivesThe incorporation of drugs in the hair of young children differs from that of adults and the metabolism of cannabis cannot be the same. Our primary objective was to analyze the distribution of the different cannabinoids in children’s hair samples. The secondary objective was to correlate the intensity of toxic environmental exposure to cannabinoid metabolite levels. MethodsThis was a prospective, single-center, observational pilot study of a pediatric cohort. Included subjects were all children less than 6 years of age admitted to a tertiary pediatric emergency unit for proven cannabis intoxication during the reference period. A hair strand was sampled within 12h of emergency admission. ResultsForty-one pediatric patients were consecutively enrolled. Hair analysis showed that 34 children were positive for Δ9-THC (range 0.06–284.4ng/mg); 41 % of them were also positive for THC−COOH (range 0.26–2.76pg/mg). Depending on the Δ9-THC concentration (>1ng/mg), 39 % of the children could be considered exposed to an intensely toxic environment. The rate of THC−COOH detection steadily increased from 2015 to 2018 (18 %, 40 %, 50 %, 58 % for each consecutive year). Children intensely exposed weighed less on admission (p=0.02), had more comatose presentations (p=0.02), and more previous social issues (75 % versus 12 %, OR 22.0, p=0.0002). ConclusionHair testing in this context indirectly shows the intensity of children’s toxic environmental exposure by the cannabinoid metabolite threshold. This was very helpful during the collegial examination of the toddlers’ environment and led to a full investigation and to appropriate decisions concerning social measures.

Assessment of Nursing Staff Preparedness during Critical Situations at Pediatric Emergency Units

Assessment of Nursing Staff Preparedness during Critical Situations at Pediatric Emergency Units

Pattern of Blood Specimen Rejection at a Nigerian Public Clinical Laboratory

Obtaining appropriate blood specimen is central towards provision of reliable results in a clinical laboratory. To ensure that blood specimen collected for analysis reflect the physiologic or pathologic processes they represent, potential sources of pre-analytic errors should be identified and avoided. Our study aimed at determining the pattern of blood specimen rejection in a public clinical laboratory with a view of identifying inadequacies that should be improved upon. The sample rejection register at the Haematology laboratory of Usmanu Danfodiyo University Teaching Hospital Sokoto, Northwest Nigeria was accessed for a two-year period data on number of specimens rejected, reasons for rejection, types of tests for which rejections were made and affected clinical units; and the retrieved data were analysed using Microsoft Excel 2010. Of the 53,955 specimens received during the study period, 122 were rejected giving an overall specimen rejection rate of 0.23%. Incomplete specimen labelling and clotted specimens were the commonest reasons for specimen rejection having accounted for 59.8% (73) and 30.3% (37) of the rejections respectively. Coagulation Screening Tests and Packed Cell Volume had the highest rejection rates of 52.5% (64) and 18.0% (22) respectively. The Accident and Emergency (A&amp;E) and Emergency Paediatric Unit (EPU) recorded the highest rates of sample rejection with 31.1% (37) and 11.8% (14) rejection rates respectively. We concluded that the reasons for blood specimen rejection in our public clinical laboratory could be avoided via the use of appropriate and properly labelled specimen containers and avoidance of faults in specimen collection, storage and transportation to the laboratory.

BRONQUIOLITIS AGUDA:TRATAMIENTO DE LA INSUFICIENCIA RESPIRATORIA

La insuficiencia respiratoria aguda (IRA) causada por bronquiolitis aguda (BA), cuya principal etiología es el virus respiratorio sincicial (VRS), es la principal causa de hospitalizaciones en menores de 2 años durante los meses de invierno, especialmente en grupos de riesgo. Su manejo se basa principalmente en medidas generales, administración de soporte respiratorio con oxigenoterapia estándar, ventilación no invasiva (VNI), ventilación mecánica invasiva (VMI) o la emergente terapia con cánula nasal de alto flujo (CNAF), que se ha transformado en los últimos años en una alternativa de fácil uso, bien tolerada, segura para ser usada en los servicios de urgencia, salas básicas y unidades de cuidados intensivos pediátricos (UCIP). La elección de la terapia a utilizar dependerá de la gravedad del paciente, del nivel de complejidad del centro asistencial y de la experiencia en las distintas modalidades de tratamiento del equipo de salud. Es fundamental realizar protocolos y guías de manejo de tratamiento de la IRA causada por BA tanto para servicios de urgencia, salas básicas como cuidados intensivos pediátricos.

Diagnosis of foreign body aspiration with ultralow-dose CT using a tin filter: a comparison study

PurposeSuspected airway foreign body aspiration (FBA) is a common event in paediatric emergency units, especially in children under 3 years of age. It can be a life-threatening event if not diagnosed promptly and accurately. The purpose of this study is to compare the diagnostic performance of an ultralow-dose CT (DLP of around 1 mGycm) with that of conventional radiographic methods (fluoroscopy and chest radiography of the airways) in the diagnosis of FBA children’s airways.MethodsRetrospective cross-sectional study. Data from 136 children were collected: 75 were examined with conventional radiographic methods and 61 with ultralow-dose CT. Effective doses were compared using independent t tests. The results of bronchoscopy, if performed, were used in creating contingency 2 × 2 tables to assess the diagnostic performance between modalities. An extra triple reading of all images was applied for this purpose.ResultsThe effective doses used in the ultralow-dose CT examinations were lower compared with those in conventional methods (p < 0.001). The median dose for CT was 0.04 mSv compared with 0.1 mSv for conventional methods. Sensitivity and specificity were higher for ultralow-dose CT than those for conventional methods (100% and 98% versus 33% and 96%) as were the positive and negative predicted values (90% and 100% versus 60% and 91%).ConclusionUltralow-dose CT can be used as the imaging of choice in the diagnosis of airway FBA in emergency settings, thereby avoiding concerns about radiation doses and negative bronchoscopy outcomes.

SUN-066 ELECTROLYTE ABNORMALITIES IN CHILDREN ADMITTED TO THE EMERGENCY UNIT OF A TERTIARY HOSPITAL IN NORTHERN NIGERIA

Abnormalities of electrolytes are common in children, particularly in those presenting to the emergency unit of a hospital, with attendant morbidities and mortality. Many centers do not know the magnitude of electrolyte derangements in children admitted to their paediatric units. This study determined the prevalence and pattern of electrolyte abnormalities seen in the emergency paediatric unit (EPU) of Aminu Kano Teaching Hospital over a period of six months. The laboratory records of all children who had their serum electrolytes urea and creatinine checked on admission to the EPU between January and June 2017 were reviewed. Normal values from established and published reference ranges were used for comparison. Basic sociodemographic data was also retrieved from the records. Data collected was analysed using the SPSS version 16.0. A total of 846 children aged between 1 month and 13 years were admitted to the unit during the period. Male to female ratio was 1.5:1. Five hundred and thirty-two children (62.9%) were aged five years and under. Electrolyte abnormalities were distributed as follows: Hyponatraemia 46.9 % (of which 14.9% had severe hyponatraemia), hypernatraemia 8.5%, hypokalemia 26.4% (of which 16.3% had severe hypokalemia), hyperkalemia 6.5%. Serum urea levels were higher than the upper limit of normal in 22.4% of the children while serum creatinine was greater than 1.5 times the upper limit of normal in 33.1%. Children aged five years and younger accounted for 58.7% of those with elevated urea levels, and 70.7% of those with elevated serum creatinine levels. There were significant associations between age category and derangements in serum potassium, urea and creatinine (p < 0.05 in all cases). Electrolyte abnormalities, especially hyponatraemia, were present in almost half of the children admitted to the EPU. Children aged five years and younger were more affected than older children. Routine measurement of serum electrolytes and creatinine in children admitted to emergency paediatric units cannot be overemphasized.

Metoclopramide-Induced Acute Dystonia: Data From a Pediatric Emergency Unit.

Metoclopramide is a commonly used medication in pediatric practice, and dystonia is a common adverse effect of it. The present study aims to evaluate the clinical characteristics of metoclopramide-induced acute dystonic reactions (MIADRs) in pediatric patients admitted to the pediatric emergency unit. Twenty-eight patients were admitted with MIADRs between June 2004 and April 2016; they were enrolled into the study retrospectively. The study group was composed of 13 females and 15 males with the mean ± SD age of the females higher than that of the males, 12.3 ± 4.5 and 7.8 ± 4.3 years, respectively. Only 9 (32.1%) of the patients were diagnosed as MIADRs at the time of admission. Seventeen patients (60.7%) received over the recommended daily dose of metoclopramide. Dystonia was focal in most of the patients, with the most affected parts consisting of the neck, eyes, and orolingual regions. In 9 of the patients, the dystonia was episodic in nature. Pharmacological treatment was used for 18 patients. No patients died, and none suffered long-term injury related to MIADRs. Metoclopramide administration may be associated with the occurrence of acute dystonic reaction. Metoclopramide-induced acute dystonic reactions may be misdiagnosed, so detailed medical history gathering and a high index of suspicion are warranted. Our data suggest that MIADRs may be dose related and that there may be age- and sex-related differences in the epidemiology of MIADRs.

Pediatric ocular trauma: Characteristics and outcomes among a French cohort (2007–2016)

Pediatric ocular trauma is a major cause of acquired monocular blindness. Post-traumatic visual impairment can lead to significant handicap. In France, recent data on the epidemiology of pediatric ocular trauma are lacking. AimTo describe the characteristics of a pediatric cohort with ocular trauma and to analyse patient outcomes. Material and methodsThis was a retrospective observational study of pediatric ocular trauma (age<15 years) presenting to pediatric and ophthalmology emergency units of our tertiary university hospital between January 1, 2007 and December 31, 2016. Data were collected on: age, sex, time and circumstances of trauma, injury type and location, trauma mechanism, other associated injuries, hospitalisation rate and length of stay, treatment, and sequelae (visual impairment). Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system and the Ocular Trauma Score (OTS). ResultsA total of 337 children were included (247 males). The global mean age was 8.4±4.1 years (range 6 months to 14.9 years). The trauma occurred at home (51%) or in a public area (21%). Blunt objects (22%) and direct trauma (17%) were the main mechanisms. According to the BETT, 23% of ocular traumas were open-globe traumas (OGT): penetrating (n=39), perforating (n=12), with intraocular foreign body (n=24). Among closed-globe injuries (CGT), hyphema was the most frequent lesion (22%). Associated injuries were recorded in 32 patients. In all, 63% of patients had an OTS of 5 (good visual prognosis) while 39 children (12%) had an OTS of ≤3. In 47 patients, there was an initial surgery; 62% of children were hospitalised. By the end of the ophthalmic follow-up, 32 patients (9.5%) had sequelae. Children aged between 2 and 5 years had the greatest proportion of sequelae (15%). Compared with female patients, male patients were older (P=0.0007) and were more frequently injured by projectiles (P=0.036). Compared with CGT, OGT were more frequent among younger children (P=0.0015). Ocular injuries secondary to a projectile and spring-summer accidents were associated more frequently with a poor visual prognosis (OTS ≤3; P=0.036, OR=2.5 [1.1–5.8] and P<0.0001, OR=5.8 [3.2–10.7] respectively). CommentsThe annual admission for pediatric ocular trauma was stable during the study period (200 cases per 100,000 annual trauma admissions in the first period [2007–2011] and 195 cases per 100,000 during the most recent period [2012–2016]). Projectiles such as Airsoft gun bullets and paintball are still the cause of severe injuries while reports on ocular injuries secondary to blaster or Nerf guns use are starting to be published. ConclusionThe great majority of ocular traumas could be prevented, especially by wearing protective goggles during at-risk activities. French legislation should be stricter about the sale of any Airsoft gun to children under 18 years old. Parents must repeat educational warnings to their children handling sharp objects. The social and psychological burden of relative visual impairment is of importance: One in ten children will have a permanent visual defect.

A case report of a mild form of multiple acyl-CoA dehydrogenase deficiency due to compound heterozygous mutations in the ETFA gene

BackgroundMultiple acyl-CoA dehydrogenase deficiency (MADD), previously called glutaric aciduria type II, is a rare congenital metabolic disorder of fatty acids and amino acids oxidation, with recessive autosomal transmission. The prevalence in the general population is estimated to be 9/1,000,000 and the prevalence at birth approximately 1/200,000. The clinical features of this disease are divided into three groups of symptoms linked to a defect in electron transfer flavoprotein (ETF) metabolism. In this case report, we present new pathogenic variations in one of the two ETF protein subunits, called electron transfer flavoprotein alpha (ETFA), in a childhood-stage patient with no antecedent.Case presentationA five-year-old child was admitted to the paediatric emergency unit for seizures without fever. He was unconscious due to hypoglycaemia confirmed by laboratory analyses. At birth, he was a eutrophic full-term new-born with a normal APGAR index (score for appearance, pulse, grimace, activity, and respiration). He had one older brother and no parental consanguinity was reported. A slight speech acquisition delay was observed a few months before his admission, but he had no schooling problems. MADD was suspected based on urinary organic acids and plasma acylcarnitine analyses and later confirmed by genetic analysis, which showed previously unreported ETFA gene variations, both heterozygous (c.354C > A (p.Asn118Lys) and c.652G > A (p.Val218Met) variations). Treatment was based on avoiding fasting and a slow carbohydrate-rich evening meal associated with L-carnitine supplementation (approximately 100 mg/kg/day) for several weeks. This treatment was maintained and associated with riboflavin supplementation (approximately 150 mg/day). During follow up, the patient exhibited normal development and normal scholastic performance, with no decompensation.ConclusionThis case report describes new pathogenic variations of the ETFA gene. These compound heterozygous mutations induce the production of altered proteins, leading to a mild form of MADD.

Accuracy evaluation and comparison of three blood glucose meters in an emergency paediatric unit of a tertiary hospital in Nigeria

Backgrounds: Advances in technology have made available different types of glucose meters for use at the patient's bed side with significantvariation in accuracy among these glucose meters.Objectives: We evaluated the accuracy of three commonly used glucose meters in a children emergency room using laboratory method as reference.Subjects: Subjects were 206 children seen in emergency room over a period of 3 months.Methods: Capillary blood glucose was determined at the bed side using three glucose meters: Accu - Chek® Active, On Call® Plus and One Touch®Ultra Mini. Peripheral venous blood was simultaneously collected for comparative plasma glucose analysis at the laboratory. The mean absolute relative deviations (MARDs) were determined. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.Results: The MARD for Accu - Chek® Active, On Call® Plus and One Touch® Ultra Mini were 11.58%, 27.00%, and 13.91% respectively. In the diagnosis of hyperglycaemia, the sensitivity and specificity for Accu - Chek® Active, On Call® Plus, One Touch® Ultra Mini were 83.3% and 96.3%, 94.4% and 79.3%, 94.4 and 94.7% respectively. The PPV and NPV for Accu - Chek® Active, On Call® Plus, One Touch® Ultra Mini were 68.1% and 98.4%, 30.4% and 99.3%, 62.9% and 99.4% respectively. Four cases of hypoglycaemia were detected by the laboratory method and the 3 glucose meters detected 3 out of the 4 correctly.Conclusion: These three glucose meters varied in accuracy but the glucose values by the Accu - Chek® Active had the least variation from thelaboratory results. Key Words: Glucose meter, hyperglycaemia, hypoglycaemia, Dysglycaemia, Emergency Paediatric Unit.

The clinical profile and outcome of children with acute malnutrition in a tertiary health center in North-West Nigeria: A 1-year retrospective review

Background: Acute malnutrition is broadly classified as severe acute malnutrition (SAM) or moderate acute malnutrition (MAM). It affects almost 20 million children worldwide, with majority of the cases in developing countries. In Africa, it was estimated that about 5%–15% of deaths in children age ranging from 0 to 59 months are due to SAM. Therefore, this study sought to determine common clinical features and outcome in children with acute malnutrition. Methods: A retrospective descriptive study was conducted at the Federal Medical Centre Birnin Kudu, Jigawa State. Case files of patients admitted into the Emergency Pediatric unit and Ppediatric Medical Ward over the period of 1 year (January–December 2017) with a diagnosis of acute malnutrition were reviewed. Results: There were 123 cases of acute malnutrition during the study period: 53 (43.1%) males and 70 (56.9%) females. There were 103 (83.7%) cases of SAM and 20 (16.3%) cases of MAM. Among the SAM cases, there were 70 (56.9%) cases of marasmus, 10 (8.1%) cases of kwashiorkor, and 23 (18.7%) cases of marasmic kwashiorkor. Infection was the most common morbidity associated with SAM. Relatively death was mostly witnessed in the marasmic kwashiorkor subgroup (17.4%). However, majority of the subjects who spent 1–2 weeks on admission were discharged without complications, while death occurred mostly in those who spent <7 days on admission and this observation was statistically significant (Fisher's exact = 32.351, P = 0.001). Conclusion: Marasmus remains the most common form of SAM, and infection is a common comorbidity; however, majority of our cases were discharged without any noticeable complication.

Is there any relationship between initial hematological parameters and severity of scorpion envenomation?

Most cases of severe scorpion envenomation occur in children and are associated with significant morbidity and mortality. Excessive systemic inflammatory response, which leads to multiple organ involvement, is an emerging challenge during severe envenomation. The aim of this study was to investigate if there was any relationship between initial hematological parameters and severe envenomation in pediatric patients presenting with scorpion envenomation. This study was performed retrospectively, at the pediatric emergency unit and pediatric intensive care unit of the Çukurova University Medical School in Turkey. Two hundred and fifty-seven cases with scorpion envenomation, and a control group consisting of one hundred and fifteen healthy children were included in the study. White blood cell, neutrophil, lymphocyte, platelet, neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR) and PDW values of patients were higher than the controls (p < 0.05). Mean NLR was 3.8 ± 4.7 in patients. Patients were analyzed with the help of the decision tree model, and it was seen that in patients who had applied to hospital in less than an hour after the scorpion sting, 87.5% of the patients whose NLR value was between the 0.519-1.969 interval (below 2.1 which we found as the cut-off value) did not need to be hospitalized in the intensive care unit, 54.1% of the patients whose NLR value was higher than 1.969 needed to be hospitalized at the intensive care unit. Severe envenomation is associated with mortality and morbidity in children. Our findings showed that NLR seems to be a useful tool in predicting severe envenomation.

Critically Ill Children Admitted into the Paediatric Emergency Unit of a Tertiary Hospital in a Developing Country and the Causes of Delayed Presentation

Decades of advancement in health care delivery and clinical practice may have massively impacted the efficiency of health delivery and patient outcome in high-income countries, but its effect is still minimal in the low-income countries who are still dealing with poorly equipped and inadequate health facilities low insurance coverage and poor education. This study set out to evaluate the clinical profiles of critically ill admitted into the paediatric emergency unit and causes delay presentation. A prospective review of children admitted into the children emergency room between January 2018 to December 2019. A total of 8087 emergency room visits were attended to over the two years out of which 4039 were admitted. The majority of participants (63.5%) are less than 5 years, there was a male to female ratio of 1.6:1 and 1458 (36.1%) had emergency signs necessitating resuscitation at presentation. 74% of participants have been self-medicated by parent/caregiver before presenting in the hospital (50% antibiotics, 44% antimalaria). The most frequent symptoms include fever, vomiting, breathlessness and seizures, majority (73%) of those with emergency sign presented 48 hours after onset of symptoms and the major reason for the delay was the fear of the cost of treatment. Children that had significant odd of dying include those that: were self-medicated, had emergency signs and under- 5 children. The high dependence of out-of-pocket financing in Nigeria health care system remains a major cause of delayed presentation among critically ill children. There is an urgent need for the government to improve on the universal health coverage by improving the number of the population with health insurance coverage.

A review of pediatric mortalities in the emergency units of Nigerian tertiary hospitals

Background: Information on causes of death is needed to assess trends in disease burden, prioritize interventions, plan for their delivery, and ascertain the effectiveness of disease-specific interventions. The aim of this study was to review the postneonatal mortality pattern in the different pediatric emergency units of the tertiary hospitals across the country, and to propose ways of strengthening the emergency units for more effective health service delivery. Materials and Methods: Available literature on mortality in pediatric emergency units across the tertiary health institutions in Nigeria was reviewed. Neonates as well as studies that combined ward admissions with emergency room admissions were excluded. Analysis was mainly descriptive and results presented using prose, tables, and charts. Results: A total of 11 studies were analyzed. The crude mortality rate was 82 per 1000 admissions. Approximately 60% of the deaths occurred within the first 24h of presentation. The major causes of death were severe malaria (17.9%), sepsis (14.5%), acute gastroenteritis (13.7%), pneumonia (8.9%), and protein-energy malnutrition (97.7%). Sepsis and severe anemia had the highest case fatality rates, with 20.0% and 19.6%, respectively. Late presentation, unconsciousness, seizure, and severe pallor were some of the identified risk factors. Conclusion: Communicable diseases remain the major cause of mortality in our emergency units. Strengthening and restructuring of the emergency units in terms of manpower and services will help in lowering the mortality rates.

The effect of differential site of application of the pulse oximeter in critically ill children seen in a tertiary health center

Introduction: Pulse oximeter is useful in the management of the critically ill child; it gives meaningful information for immediate clinical decision-making. The fingertip probe is the most common supplied probe in most hospitals, especially in resource-limited settings, and these may not fit all pediatric age groups; hence, it is not uncommon to see such probes been applied to bigger sized digits such as the toe in younger aged children. This study therefore sought to determine if there was any difference in the SpO2 readings from those varied sites. Materials and Methods: This study was cross sectional involving 100 children seen in our pediatric emergency unit. Results: There were 59 (59.0%) males and 41 (41.0%) females with male to female ratio of 1.4:1. The age ranged from 1 to 12 years with mean of 6.0 ± 3.4 years. The mean pulse oximetry between the various pairs was almost similar for all the sites; however, this observation was not statistically significant (t = 0.269, df = 70, P = 0.789). There were significant agreements between all the studied methods of comparison of SpO2. However, this was most noticeable for the right index finger and left index finger. Conclusion: This study showed that SpO2 can be measured from any digit.

Impact of a Multidisciplinary Sepsis Initiative on Knowledge and Behavior in a Pediatric Center.

Our institution performed an educational initiative targeting previously identified barriers to pediatric sepsis recognition and treatment. We hypothesized that provider knowledge, attitude, and behavior would be improved 1 year after implementation. This was a prospective, observational study of a multi-faceted quality initiative introduced to providers in the Emergency Department, inpatient wards, and Pediatric Intensive Care Unit of a tertiary care children's hospital. Educational platforms consisted of quarterly electronic sepsis "newsletters," brightly colored posters highlighting protocol and screening strategies displayed throughout the hospital, and low-fidelity simulation sessions (drills) led by trained staff and incorporated into daily workflows. The content was driven by feedback from a baseline needs assessment of sepsis education. One year after implementation, the needs assessment was repeated. Over 3 months, facilitators conducted 197 drills and captured a majority of nurses (89%), pediatrics residents (96%), and respiratory therapists (62%). By 6 months, 241 sessions had been completed. Approximately 55.4% of the 442 eligible staff participated in our post-intervention survey. Overall, knowledge of diagnostic criteria for pediatric sepsis and septic shock increased from pre-intervention levels (P = 0.015). Among post-implementation respondents, drill participants outperformed their colleagues (P = 0.001). A greater percentage of post-intervention respondents indicated comfort with sepsis recognition (P < 0.001), and fewer reported hesitating to bring sepsis concerns to their care team (P < 0.01). Our findings suggest that a multidisciplinary curriculum balancing active education-through brief, targeted simulation-and general awareness-through electronic resources and a poster campaign-can improve sepsis-related knowledge, attitude, and behavior among pediatric practitioners.

A new stethoscope for pediatric intensivists: Point-of-care ultrasound.

In recent years, the use of point-of-care ultrasound by non-radiologist physicians has become widespread. Especially for clinicians working in pediatric emergency departments and pediatric intensive care units, point-of-care ultrasound has almost become a part of physical examinations due to the rapid responses it offers to the problems of critically ill patients. Numerous studies revealed the important clinical benefits of point-of-care ultrasound use by pediatric intensive care providers. In this review, we aimed to give detailed information about different types of point-of-care ultrasound applications in pediatric intensive care units and wanted to draw attention to the increased use and clinical benefits of this noninvasive and radiation free technique.

The determinants of emergency room visits and missed school days in children with asthma in a tertiary hospital in north central Nigeria

Background: Asthma is a major cause of emergency room visits and missed school days. However, the magnitude of this problem in Nigeria is yet to be evaluated. This study assessed the number of emergency room visits, missed school days as well as identified their determinants. Methods: This was a cross-sectional study carried out in the Paediatric Respiratory Clinic and the Emergency Paediatrics Unit of a tertiary hospital. The number of missed school days and emergency room visits were calculated and extrapolated for the estimated population of children with asthma in the state. Results: A total of 60 children with a male to female ratio of 1: 0.6 were studied. There were an estimated 5.3 million missed school days and over 460,000 emergency room visits per year for children with asthma in Plateau state. The commonest reasons for emergency room visits were severe acute exacerbation, poor knowledge of self-management and non-response to inhaled bronchodilators while the duration of asthma diagnosis, family member with atopy, family history of asthma and exercise intolerance were the determinants of emergency room visits and missed school days. Conclusion: With 5.3 million missed school days and over 460,000 emergency room visits in a year, asthma is a disease of significant public health importance. Self-management at home must be well taught at the beginning to all the patients. Care givers and patients need to know when they need to seek for help and not wait till the acute exacerbations are severe before presenting to the hospital.

The status of drug wastage in the pediatric emergency department of a tertiary hospital.

ABSTRACTBackground:The aim of this study was to evaluate surplus drugs left over from medications used via the intravenous and intramuscular routes in a pediatric emergency unit of a tertiary hospital in Turkey and to determine the financial burden imposed by drug wastage.Materials and Methods:The study was planned prospectively on patients presenting to the pediatric emergency department of a tertiary university hospital between January 1 and April 30, 2017, on weekdays and between 08:00 and 16:00, for any reason, and receiving intravenous and/or intramuscular drug administration resulting in drug wastage after treatment.Results:The number of patients enrolled in the clinical trial was 1620 (35.9%). Twenty-one different medications were administered via the intravenous or intramuscular (IM) routes during the study. The proportion of total medication wastage at the end of trial was estimated to be 0.425. The drug with the highest proportion of mean wastage to drug form was paracetamol (1000mg vial) at 0.79. The total cost of the drugs used for the patients in the study was US$580.98, and the overall burden of drug wastage was US$288.09. The three medications involving the highest wastage costs were methylprednisolone, ondansetron, and dexamethasone. The total wastage cost/total drug cost ratio was 0.495.Conclusion:If commercial drugs with intravenous and IM formulations are used by the pediatric age group, then dosage formulations appropriate for pediatric age group use also need to be produced. The development by manufacturers of ampoules and similar products suitable for multiple use will also reduce drug wastage. Reducing levels of drug wastage will inevitably reduce the drug expenditure.